Preventive Paediatrics

EDITOR'S WORD

2025-03-18T06:53:54+01:00

Dear readers, authors, colleagues, students, collaborators and all members of the friendly group of preventive pediatrics,

It is my pleasure to invite you to browse the latest issue of the Journal of Preventive Pediatrics, find interesting articles and newspapers, or just confirm your previous knowledge. After a full 10 years of the Journal as well as for this 11^th year, I can say that it is challenging but also fulfilling the expectations and demands of me as an Editor and all my assistants and collaborators. We especially value the topics presented by younger colleagues.

In this issue you will find the outstanding articles in the field of primary health care, children’s mental health, children’s surgery, prevention of child abuse, prevention of exposure to tobacco smoke, prevention of the consequences of premature birth, prevention and treatment of obesity, clinical case reports spectacular from topics to competence and exclusivity.

Do yourself and us a favor and take some time to read these articles, we are sure that there will be new and interesting aspects about topics that we never thought would be in our focus.

And of course, we do not end the list of news but continue with the presentations at the Congress of the Association of Preventive Pediatrics of Serbia, which I sincerely hope you will follow live. We draw your attention to one of current topics: the use of electronic cigarettes by school children and adolescents, a growing and stressful problem in all ages even in children aged 13 to 15 years. There more and more users of e-cigarettes and other nicotine preparations, and critical knowledge about possible harmful effects is insufficient. The only thing that is certain is that, with their forms, colors, smells, tastes and various provocative decorations, they attract young people. Legal regulations on media promotions of these preparations do not exist, as is the case with “classic tobacco cigarettes”. Professional organizations from the World Health Organization, the European Respiratory Society, the European Academy of Pediatrics and many others have expressed clear views that it is not about less harmful inhalation of nicotine preparations nor about the expected facilitating way of quitting tobacco cigarettes, and uncontrolled sale and use by children, adolescents, and pregnant women cannot be tolerated. Every day we meet very young people on the streets, young mothers pushing a stroller with a baby, and carrying an electronic cigarette or "vape". Media campaigns on all social networks are relentless, and it is hardly surprising that the expansion of the use of these products has occurred. We have knowledge about the harmful effects, many tests have been done on animal models, but for concrete and obvious evidence in human population, it is still early. One of the most dangerous consequences is the possibility of addiction that the additives in electronic as well as tobacco cigarettes can cause.

That is why it is our duty to address children, adolescents, young women of reproductive age, and try to clarify the risks that it imposes.

The next thing that attracts our attention every day in professional literature is nutrition at all ages, as a risk factor for many diseases and conditions, from allergies, obesity to cardiovascular and mental problems. The main target is the so-called "fast" food or ultra-processed food. In such food, there are always chemical additives (color, smell, taste enhancers), and this often stands out as the biggest problem, especially for people with allergies. But, the latest data show that the main ingredients: sugar, salt and flour, are actually the worst causers of addiction to this kind of food. With such a way of eating, physical inactivity, lack of motivation to do sports, isolation from the environment, peers and nature, the path to obesity is straight. For people with allergies, when individual foods are not a problem, but in combination and processed more than once, they become risky, it is especially important to avoid super-processed or so-called fast food.

We will not skip over the topic of excessive use of drugs and aids, in all areas of medicine, but the consequences are the most severe in children. Excessive use of antibiotics, syrups with sweeteners and aromas, anti-asthmatic drugs for all respiratory problems and without time limits, lead to sometimes chaotic and futile treatments. A few months ago, Prof. Andrew Bush, Great Britain, wrote an article entitled: Stop the Asthma Treatment Elevator, We Need to Get Off! The text emphasizes that an increasing number of children, on the advice of a doctor of course, are using anti-asthmatic drugs (mainly inhalers) for more and longer periods of time and for ailments that are not defined as asthmatic. We know for sure that corticosteroid therapy is effective in patients with allergic asthma (Th2 inflammatory response), but for other entities the response and validity of this therapy is questionable. During the Covid19 pandemic, due to the lack of adequate control of patients by their pulmonologists, therapy was prolonged unnecessarily. In this way, the opinion of both patients and doctors that anti-asthma therapy is recommended for various complaints and with an unlimited duration has become widespread. Such an attitude must be corrected, and Prof. Bush, in his article, supported criticality and acting according to the evidence.

(Bush, I Pavord. Stop the Asthma Treatment Elevator, We Need to Get Off! AJRCCM Articles in Press. Published January 21, 2025 as 10.1164/rccm.202412-2431VP. https://doi.org/10.1164/rccm.202412-2431VP)

Dear readers, colleagues, collaborators, do your best to avoid the pitfalls of such facts in your future work, and thus protect all children, and especially child patients, from unnecessary examinations, treatment and complications that can arise from anything.

That would be our mutual reward and success!

Prof. Zorica Živković, MD, PhD
Editor-in-Chief of the journal Preventive Paediatrics
Medical Center “Dr Dragiša Mišović“ Belgrade, Serbia
Children’s Hospital for Pulmonary Diseases and Tuberculosis
Faculty of Pharmacy, Novi Sad,
Business Academy, Novi Sad, Serbia
Exam Committee Member pediatric HERMES, European Respiratory Society
C4C Respiratory and Ethic Expert Group
https://orcid.org/0000-0003-0363-3578
http://www.researcherid.com/rid/E-2663-2018

AN OVERVIEW OF NEUROPROTECTIVE STRATEGIES IN PRETERM NEONATES

2025-02-13T06:55:16+01:00

With advances in antenatal and neonatal therapy and care, the survival of preterm neonates, especially extremely immature, has increased. Brain injury occurs significantly more often in preterm neonates compared to full-term neonates, which is associated with a higher risk of neurodevelopmental disorders. Three common and frequent forms of preterm brain injury are intraventricular hemorrhage, white and gray matter injury. There are numerous antenatal, intrapartum and postnatal strategies in order to reduce risk of preterm brain injury and poor neurodevelopmental outcome. First of all, studies showed that antenatal corticosteroid and magnesium sulfate administration in case of threatened preterm delivery has an importance role in reducing the risk for preterm brain injury and neurodevelopmental disabilities. Also, delayed cord clamping and many interventions in early neonatal period, such as maintenance of optimal ventilation and hemodynamic stability, blood glucose monitoring concentration, recognition of neonatal seizures and administration of anti-seizure medications, use of caffeine and optimal nutrition affect the improvement of the neurological development of the preterm neonates. At the end of the 20th century, a special program for the care and assessment of the behavior of neonates, Neonatal Individualized Developmental Care and Assessment Program, was developed, which is used today in many neonatal intensive care units in order to minimize developmental delays of preterm neonates. A number of drugs and interventions whose possible neuroprotective effects are being investigated include mild hypothermia, erythropoietin, melatonin, allopurinol, stem cell therapy, maternal vitamin D supplementation during pregnancy, exosomal-based therapy, et al.

SCREENING OF DEPRESSIVE AND ANXIETY DISORDERS IN ADOLESCENTS WITH EPILEPSY

2025-02-13T06:43:34+01:00

Epilepsy is the most common chronic neurological disorder in childhood, negatively affecting the physical, psychological, and social functioning of those affected and their families. Around 21-60% of adolescents with epilepsy develop mental disorders, with the most common being depressive and anxiety disorders which significantly impact quality of life. Depression increases the risk of behavioral problems, substance abuse, and other social issues. Anxiety disorders, such as panic disorder and social phobia, are also common among adolescents with epilepsy, with the possibility of developing more severe psychopathological conditions. These disorders often go unrecognized and inadequately treated, increasing the risk of symptom worsening. It is important to conduct screening for depressive and anxiety symptoms in adolescents with epilepsy. The recommendation is to implement screening questionnaires for the early detection of these disorders. Early recognition of symptoms allows for proper referral to psychological treatments, which can improve patients' quality of life, compliance, and reduce the risk of disease deterioration.

THE IMPORTANCE OF INTERDISCIPLINARY COLLABORATION IN IMPROVING ACADEMIC ACHIEVEMENT IN CHILDREN WITH MULTIPLE SCLEROSIS

2025-02-08T06:34:28+01:00

Introduction: Multiple sclerosis (MS) in the pediatric population is more and more frequently reported. Given the age of onset, pediatric multiple sclerosis has more severe psychosocial implications for children and their families. The prognosis and disease course have distinctive characteristics that differentiate it from the adult form.

Objective: The main goal of this literature overview is to examine the impact of pediatric multiple sclerosis symptomatology on growth, development, academic achievements and quality of life, with an emphasis on the importance of interdisciplinary collaboration within healthcare, social protection, and education systems.

Method: A comprehensive literature overview was conducted using the following databases: PubMed, Google Scholar, and COBSON.

Results: The negative impact of pediatric multiple sclerosis on gross and fine motor skills, graphomotor skills, visual functions, cognitive and executive functions, speech, language and communication, socialization, mental health, and consequently, academic success and overall quality of life is evident. Pediatricians play a key role in the early identification, treatment, and monitoring of the child, as well as collaboration with teachers and special educators. Guidelines were identified for working with teachers and school staff, including: accommodation of the physical environment, organization of teaching materials, tests and homework, monitoring of the child’s behavior, and other specific requirements that need to be addressed,

Conclusion: The pediatrician has a significant role in the early identification, treatment and monitoring of the child, as well as in cooperation with teachers and support staff members. A transdisciplinary, individualized, and personalized approach to children with MS, alongside adherence to guidelines in the school environment and beyond, and the active involvement of pediatricians in the team, will positively influence the academic achievements, quality of life of the child and their family, and all that it encompasses.

PROTECTING CHILDREN FROM ABUSE AND NEGLECT – PEDIATRIC APPROACH

2025-02-28T11:45:55+01:00

Child abuse and neglect includes physical, sexual, emotional abuse, neglect and exploitation of children, which lead to damage to the health or threaten the dignity of the child. It is also generally referred to as violence against children. Four groups of factors are most often mentioned (parental characteristics, sociocultural factors, environmental factors and child factors) that increase the risk of child abuse and neglect. There are no characteristic anamnestic data and clinical signs of abuse, but there are data and signs that can indicate this problem with high probability. Pediatricians and nurses are often among the first to whom a child or their relatives turn for help. In order to achieve the goals of protecting children from abuse and neglect, it is necessary to establish good cooperation between experts from all fields that work with children (health, education, social protection, police, justice and others). However, it should be remembered that abuse can occur in all environments and that the child is never at fault. It is necessary to recognize risk factors, take care of the abused child and report suspected abuse and neglect, but also to help prevent re-victimization and chronic consequences associated with adverse childhood experiences.

IMMUNIZATION OF PATIENTS WITH NEUROLOGICAL DISORDERS – WHAT PEDIATRICIAN MUST KNOW

2025-03-04T11:17:56+01:00

Introduction: We can notice aggressive anti-vaccination rhetoric in the public. In everyday pediatric clinical practice, there are frequent dilemmas related to vaccination of children suffering from neurological diseases. The negative but also vague attitude of pediatricians regarding mandatory immunization contributes to additional confusion for parents, and on the other hand, children are exposed to serious infectious diseases that could have been prevented.

The aim of this work is to form clear and practical guidelines related to the immunization of neurologically ill children.

Method: A review of papers, relevant guides and case reports from clinical practice was performed. Neurological diseases are divided into neuromuscular, cerebrovascular and autoimmune neurological diseases, cerebral palsy as a separate unit, epilepsies, with a special focus on drug-resistant epilepsy and epileptic encephalopathies, as well as neurodevelopmental disorders, with an emphasis on delayed psychomotor development, hyperactivity. and attention disorders. Then, for each of the mentioned group. general and specific contraindications for mandatory and supplementary immunization, which is carried out in Montenegro, are listed.

Results: Most of the research on impact immunization on neurological diseases is focused on autism, acute polyradiculoneuritis, acute demyelinating encephalomyelitis and multiple sclerosis. After reviewing the academic literature, no cause-and-effect relationship was found regarding autism and vaccination. For the occurrence or relapse of the autoimmune diseases, the more common trigger than vaccines are the same infectious diseases, so the postponement of certain vaccines is suggested if the disease occurs within the sixth week of the previous dose of vaccine. In children with (progressive) epileptic encephalopathies, administration of the vaccine against diphtheria, pertussis and tetanus is contraindicated until the condition is stabilized. Additional caution is recommended in patients with epilepsy in case of administration of polyvalent vaccine against measles, rubella, mumps and varicella.

Conclusion: Very few neurological diseases are contraindications for immunization. A clear position of pediatricians on vaccination is necessary, because only with knowledge can we fight against anti-vaccination propaganda.

CHALLENGES, LESSONS LEARNED AND INTERNATIONAL COLLABORATION IN PROVIDING PREVENTIVE TREATMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS (DR TPT) IN CHILDREN IN SERBIA

2025-03-02T06:26:06+01:00

Drug-resistant forms of TB continue to be the global public health threats. Multidrug-resistant TB (MDR-TB) is defined as TB resistant to rifampicin and isoniazid, essential anti-TB drugs. Both MDR-TB and rifampicin-resistant TB (RR-TB) are treated with second line anti-TB drugs. Preventing the progression of a drug-resistant tuberculosis (DR-TB) infection to disease is an important pillar of the DR-TB elimination strategy. International guidelines have recently proposed fluoroquinolones for tuberculosis preventive therapy (TPT) in DR-TB contacts. Till 2019, no preventive therapy for MDR TB contacts has been performed in Serbia since it was not included in the national TB treatment and contact tracing guidelines. In 2019 and 2022 for the first time, several children and adolescents appeared as close contact with MDR TB cases. DR TB preventive treatment was performed at Hospital for Children's Lung Diseases and TB, “Dr Dragisa Misovic” Clinic in Belgrade, Serbia in two children aged 2 and 3, in line with latest WHO guidelines, due to international collaboration and national multidisciplinary expert support. During the implementation of TPT for child contacts of MDR TB, we have learned that our capacities for TB program coordination, international and in-country multidisciplinary expert collaboration, epidemiological investigation, contact tracing as well as DS and DR TB management in children are good. However, we faced a lot of legislation and systemic challenges that affected the implementation of DR TPT. The main challenges were lack of pediatric drug formulations, lack of indications for levofloxacin use for TB and use in this age group.

PROBIOTICS IN TREATMENT OF ATOPIC DERMATITIS - TRUE OR MYTH WHAT IS THE EFFECTIVENESS OF PROBIOTICS IN REDUCING ECZEMA SYMPTOMS AND IMPROVING QUALITY OF LIFE IN CHILDREN WITH ECZEMA?

2025-03-02T07:11:36+01:00

Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder affecting up to 20% of children. AD is usually the first step of the atopic march, with a sequential progression to respiratory allergic diseases (asthma and allergic rhinitis). The aim of this prospective real life study was to follow up the efficacy of mixture of 3x10⁹ CFU (colony forming unites) of 3 probiotic strains Lactobacillus Casei BL 2401, Lactobacillus Salivarius BL 2201, Bifidobacterium Breve BL 3406 in combination with 7mg Zinc in Hypro-ri form for better resorption and 1200 IJ Vitamin D3 (Imunolak Kids D3 Zn) in the group of children with atopic dermatitis. Tretament period was3 months. Children with mild to moderate AD who have received Imunolak Kids D3 Zn were followed up for the next 6 months after cessation of the probiotic supplementation for AD and respiratory tract diseases (including both upper and lower respiratory tract infection and exacerbation of asthma and/or allergic rhinitis in children with those comorbidities). Our observation showed that 6 months after cessation of the treatment AD was under control, while although during the study we noticed less respiratory tract diseases, 3 months of probiotic usage didn’t have prolonged effects.

MYCOPLASMA PNEUMONIAE INFECTION IN CHILDREN: WHAT WE NEED TO KNOW?

2025-02-16T08:56:52+01:00

An increase in the number of subjects suffering from infections caused by Mycoplasma pneumoniae was recorded worldwide in the 2023-2024 season, after a three-year decline during the Covid-19 pandemic. This review article investigates studies from previous outbreaks to emphasize the multifaceted nature of M.pneumoniae infections, epidemiology, diagnostic innovations, antibiotic resistance, and therapeutic challenges.

After inhalation of respiratory aerosols, the bacteria attaches itself to host epithelial cells in the respiratory tract. In addition to causing severe lower respiratory tract disease and milder upper respiratory tract symptoms, M.pneumoniae can cause extrapulmonary complications, which occur in the skin, kidneys, gastrointestinal tract, cardiovascular system, and central nervous system (CNS).

Imaging techniques (chest X-rays, CT scans, chest ultrasound), clinical assessment, and laboratory investigations (culture, serological methods, direct antigen detection and molecular-based PCR tests) are used in the diagnosis of M. pneumoniae infections. In the future, artificial intelligence (AI) could be an important tool to assist in the diagnosis of M. pneumoniae.

Macrolides are the first-line antibiotic treatment for infection and in pneumonia caused by macrolide-resistant M. pneumoniae (MRMP), tetracyclines and fluoroquinolones are recommended as second-line treatment. For severe MRMP pneumonia, systemic glucocorticoid therapy should be considered. Intravenous immunoglobulins (IVIG) therapy may be considered in case of severe extrapulmonary complications such as central nervous system damage, skin and mucous membrane lesions, hematological manifestations, myocarditis and heart failure.

HIGH-INTENSITY INTERVAL TRAINING IN THE TREATMANT OF OBESITY

2025-02-23T07:02:41+01:00

Introduction: High-intensity interval training (HIIT) is an increasingly popular method for treating obesity due to its effectiveness in reducing body weight and improving cardiometabolic health.

Objective: This study aims to explore the effects of HIIT on obesity reduction through a review of relevant literature.

Methods: Articles published between 2000 and 2021 were collected from electronic databases such as PubMed, Scindex, and Google Scholar.

Results: The findings indicate that HIIT, which consists of periods of intense exercise interspersed with rest intervals, has a positive impact on body weight reduction, fat percentage decrease, and aerobic capacity enhancement. HIIT is particularly efficient as it allows for achieving results with shorter exercise duration compared to traditional moderate-intensity aerobic workouts. Studies also show that HIIT can improve insulin sensitivity, increase VO2max, and boost metabolism, even in populations with higher body mass indices. HIIT can be performed in various settings, including indoors in gyms and outdoors in open spaces. This form of exercise is effective across different age groups, including children, adolescents, and adults, making it a universal approach in combating obesity.

Conclusion: Based on the literature review, it can be concluded that HIIT is an effective tool for reducing obesity and improving overall health in obese individuals.

THE IMPORTANCE OF COORDINATION THE HEALTHCARE TEAM AND THE FAMILY FOR THE APPLICATION OF EARLY INTERVENTIONS IN AN EMERGENCY SITUATION

2025-02-17T22:40:40+01:00

Introduction: An emergency situation must not disturb the optimal growth and development of any child. Very important factors in preserving family health and the successful functioning of the family are the application of appropriate knowledge and skills, patience, humanity and continuous teamwork of parents and experts who deal with the early development of children.

Objective: This research work is related to the improvement of the health care system for children by applying adequate measures of early intervention in an emergency situation. The goal is to determine the level of cooperation between health professionals and parents in pediatric practice.

Methods: The research was conducted in 2020 at the KBC "Dr Dragiša Mišović - Dedinje". The sample included 122 parents of hospitalized children and 63 health workers and associates. The program SPSS (Statistical Package for Social Sciences) version 25.0 was applied, the measures of descriptive statistics, frequencies and percentages were used.

Results:The results show that (95.1%) parents recognize the importance of their own involvement in the implementation of early interventions during emergency situations in cooperation with the health team, they (86.9%) are of the opinion that this way the health services will be of better quality. The opinion that the participation of parents in the application of early interventions is significant is held by (76.2%) health professionals, while (4.8%) believe that their participation is not desirable, almost one fifth is not sure. The employees of the pediatric departments included in the research are almost unanimous (95.2%) about the importance of applying RI in the health care of children, while they (85.7%) emphasize the harm of denying early interventions.

Conclusion: The multidisciplinary cooperation of all actors who directly and indirectly deal with providing early interventions during an emergency situation is crucial for better quality of health services.

PRENATAL AND POSTNATAL EXPOSURE TO TOBACCO SMOKE AS A RISK OF BRONCHIOLITIS DURING INFANCY

2025-02-10T19:17:53+01:00

Introduction: Acute bronchiolitis is the most common disease of the lower respiratory tract in children in the first year of life and a frequent reason for hospitalization of small children in the winter period. In 75% of cases it is caused by respiratory syncytial virus (RSV). A more severe clinical course of acute bronchiolitis is expected in younger children, children born before term and infants with associated diseases. Exposure to tobacco smoke is a global health problem and is considered a risk factor for the health of pregnant women and children, especially respiratory morbidity during the first year of life. They were made significant studies worldwide on the effect of prenatal, through passive and active maternal smoking, on the development of severe bronchiolitis in early childhood.

Aim: To determine whether there is a connection between maternal exposure to tobacco smoke, prenatally and postnatally, and the development of bronchiolitis in children under the age of one year in the territory of the municipality of Doljevac.

Material and methods: The examined group consisted of 80 children, 36 boys and 44 girls, aged up to 1 year, average age 8.2 months, diagnosed with bronchiolitis in the period from October 2024 to January 2025. A questionnaire was filled in by the mothers, the data was collected and statistically processed in order to determine the correlation of the obtained results.

Results: Out of the total number of examined children with bronchiolitis aged up to one year, it was determined that in 48 (60%) children with bronchiolitis, the mothers continued to consume tobacco during pregnancy, while 32 (40%) of them did not. In 65 (81.25%) children with bronchiolitis, passive exposure to tobacco smoke of the mother during pregnancy by household members was found, while in 15 (18.75%) there was no connection.

Conclusion: Our results confirm the harmful effects of passive and active cigarette smoking during pregnancy for the respiratory health of newborns and infants, as exposure to tobacco smoke in the prenatal period significantly increases the risk of developing bronchiolitis in the first year of life. Strategies to prevent passive smoke exposure in young children and pregnant women is an urgent public and children's health priority.

CESAREAN SECTION AS A RISK FOR BRONCHIOLITIS IN EARLY CHILDHOOD

2025-02-17T20:20:13+01:00

Introduction: Acute bronchiolitis is one of the most common lower respiratory tract diseases in children during the first year of life and a frequent reason for hospitalization of young children during the winter period. In 75% of cases, it is caused by the respiratory syncytial virus (RSV). A more severe clinical course of acute bronchiolitis is expected in younger children, those born preterm, and children with underlying conditions.

Aim: To determine whether there is a correlation between cesarean section and the increased incidence of bronchiolitis in children up to one year old in the municipality of Doljevac.

Material and methodology: The study group consisted of 80 children, 36 boys and 44 girls, aged up to 1 year, with an average age of 8.2 months, diagnosed with bronchiolitis between October 2024 and January 2025. A questionnaire was completed by the mothers, and the collected data was statistically processed to determine possible correlations.

Results: Among the total number of children with bronchiolitis under the age of one, it was found that 28 (35%) were born through spontaneous vaginal delivery, while 52 (65%) were born via cesarean section.

Conclusion: Since this is a retrospective study, we lacked information on whether the cesarean sections were performed electively or as emergency procedures. Our research will open many avenues for larger and more in-depth studies. Cesarean delivery appears to increase the risk of bronchiolitis when compared to babies born via vaginal delivery.

IMPACT OF THE COVID-19 PANDEMIC ON FRUIT AND VEGETABLE INTAKE OF YOUNG PEOPLE IN NIŠ, SERBIA

2025-02-26T08:51:18+01:00

Introduction: Proper nutrition has a great impact on the health of each individual, and especially on the student population, which is exposed to constant psychophysical efforts, growth and development. Fruits and vegetables are rich in minerals, vitamins and dietary fiber, and the their appropriate intake improves health and prevents non-communicable diseases. The pandemic caused by the corona virus (COVID-19) has drastically changed food shopping behavior, and the intake of some food groups has been disrupted.

Objective: The aim of the study was to examine the potential changes in fruit and vegetable intake among young people caused by the COVID-19 pandemic.

Methodology: The transversal epidemiological study was conducted during December 2022 at in Niš. The diet assessment was conducted using an anonymous 24-hour recall questionnaire. The survey included 64 students (42 female and 22 male). The obtained results were compared with the results of similar research conducted in 2002 and 2011, with a similar population. Statistical processing was performed using the MS Excel program.

Results: The study confirmed a negative trend in fruit and vegetable intake among young people in Nis in the last two decades. Potatoes, fruit and root vegetables are the most common in their diet, while green leafy vegetables and green beans are eaten less frequently. When it comes to fruit, the most consumed are apples, followed by citrus fruits.

Conclusion: The COVID-19 pandemic had an adverse effect on the average daily intake of fruits and vegetables among young people in Niš. It is necessary to strengthen the awareness of the importance of fruits and vegetables among young population, both in terms of quantity and variety, as well as the combination of foods.

IMPACT OF COUNSELING AND HIV TESTING FOR THE PREVENTION OF MOTHER-TO CHILD TRANSMISSION OF HIV - OUR EXPERIENCE

2025-02-28T06:36:43+01:00

Introduction: HIV counseling and testing for pregnant women is considered a key factor for successful prevention of mother to child transmission (MTCT), early diagnosis and treatment.

The aim of the paper was to explore the descriptive characteristics of HIV positive children due to MTCT transmission in the Nišava and Toplica District during 1987-2024, and prevalence of HIV testing and counseling of pregnant women at the Public Health Institute (PHI) Niš from 2004 to 2024.

Method: The Register of HIV positive patients, The Register of HIV tested patients, The Register of the clients attending Voluntary Confidentially Counseling and Testing Center and PHI data given in Statistical Annual and Analysis of health status of the population in Nišava i Toplica District were used as a study material. Descriptive method was applied.

Results: Eight HIV infected children were diagnosed due to MTCT, four boys and four girls aged 0-16 years, all from the Nišava District. Three infections were registered as clinical AIDS. Three deaths due to AIDS were registered. In the observed period, only 6.2% of all pregnant women in the Nišava and Toplica District were HIV tested at the PHI Niš. During the first three months of pregnancy and for the first time 19.6% were counseled and tested for HIV.

Conclusion: Despite great value of HIV counseling and testing of pregnant women for the prevention of MTCT of HIV, the rate of testing is negligible. It is important to increase collaboration with other health providers, especially gynecologists, in order to increase coverage of HIV tested pregnant women and prevent MTCT.

PENILE STRANGULATION INJURY IN THE PEDIATRIC POPULATION

2025-01-31T05:12:13+01:00

Introduction: Penile strangulation injuries in pediatric patients are a rare and urgent condition in urology. They are commonly seen in adolescents and adult males, often due to autoerotic suggestions, while in younger pediatric patients, they more frequently occur accidentally. Objects of causing strangulation are elastic and rigid items of various shapes and sizes. Reports of strangulation injuries as a result of abuse are rare.

Case outline: A 16-year-old boy was admitted to the University Children’s Hospital in Belgrade due to described penile strangulation injury inflicted by another person. The patient is under care of the Social Welfare Center ’’Sremčica’’ due to developmental and behavioral disorders. The boy is followed by psychiatrist for a psychopharmacologically treated underlying condition. Upon admission, there was a skin defect encompassing the entire circumference of the penis with fibrous deposits, pronounced lymphatic edema. Vascularization is preserved. The urethra was not damaged. The patient was hospitalized. Antibiotic and symptomatic therapy were included. Emergency surgical intervention was indicated. Psychopharmacological therapy for the boy’s underlying condition was suspended before and the day of the operation. Circumcision with penile skin reconstruction was performed. The postoperative course was uneventful, with no signs of infection or skin necrosis, and lymphatic edema was gradually subsided. The urinary catheter was removed and spontaneous urination was preserved. Therapy for the boy’s underlying condition was gradually reintroduced. After a satisfactory postoperative period, the patient was discharged with regular urological follow-up appointments and advice on maintaining hygiene of the surgical wound. It was instructed to use coban bandages and an ointment containing panthenol or antibiotic cream, and to avoid masturbation for three months after the operation.

Conclusion: Timely treatment is imperative in cases of penile strangulation injuries. Proper surgical intervention and reconstructive procedures are necessary to prevent the progression of damage and complications.

AGENESIS OF DUCTUS DEFERENS. CASE REPORT AND BRIEF LITERATURE REVIEW

2025-02-13T06:19:20+01:00

Introduction: Agenesis of the ductus deferens is a rare congenital anomaly in the male population that can be a cause of male infertility. It can be classified as unilateral or bilateral agenesis. Agenesis of the ductus deferens is most commonly detected during the evaluation of infertility or as an incidental finding during surgical procedures in the urogenital region, such as orchidopexy or vasectomy. In the pediatric population, agenesis of the ductus deferens is most frequently discovered during surgical interventions for inguinal hernia, hydrocele, or undescended testis. Agenesis of the ductus deferens is often associated with other congenital anomalies, with ipsilateral renal agenesis being the most significant. Previous studies have linked agenesis of the ductus deferens to mutations in the cystic fibrosis transmembrane regulator (CFTR) gene.

Case outline: A 5.5-year-old boy was hospitalized for planned surgery of a large right-sided hydrocele. Intraoperatively, a massive hydrocele was confirmed, and radical fenestration was performed. During exploration of the spermatic cord and testicle, agenesis of the ductus deferens, right epididymis agenesis, and right testicular hypoplasia were verified. A testicular biopsy was done, and the sample showed maturation stage appropriate for the child's age. On physical examination, both testes were described as approximately equal in size, of usual size for the child's age, normally positioned vertically in the respective hemiscrotum, and without painful tenderness on palpation. Given the intraoperative findings of agenesis of the ductus deferens, an ultrasound of the abdomen and testicles was performed, revealing agenesis of the ipsilateral (right) kidney and compensatory hypertrophy of the left kidney. The results of genetic testing for mutations in the CFTR gene were negative.

Conclusion: Congenital absence of the ductus deferens is an extremely rare anomaly, most often detected in pediatric patients during scrotal or laparoscopic surgery. If vas deferens absence is found during surgery, simultaneous laparoscopic evaluation of the contralateral inguinal canal is recommended., Due to the high association of vas deferens agenesis with urogenital anomalies, all patients diagnosed with this condition should undergo targeted ultrasound of the abdomen and urogenital tract. Given the established association between vas deferens agenesis and CFTR gene mutations, genetic testing should be considered.

LEUKEMOID REACTION AS A CONSEQUENCE OF EPSTEIN-BARR VIRUS INFECTION

2025-02-08T07:26:33+01:00

Introduction: A leukemoid reaction is defined as an increase in white blood cell count exceeding 30,000/µL, with a predominance of immature cells, commonly seen in infectious and malignant conditions. Epstein-Barr virus (EBV) is known for its cytopathogenic effect on B lymphocytes and is the causative agent of infectious mononucleosis. It has also been associated with the development of Hodgkin's lymphoma, non-Hodgkin lymphoma, and nasopharyngeal carcinoma. Although it is rare, EBV infection can cause a significant elevation in white blood cells, necessitating comprehensive diagnostic workup to differentiate infectious mononucleosis from leukemia.

Case Presentation: This report describes a case of a 3-year-old girl presenting with a 3-day history of fever (38.5°C) followed by laboratory findings of leukocytosis (53,000/µL), with a predominance of lymphocytes and monocytes. On physical examination, bilateral cervical lymphadenopathy up to 1 cm in diameter was noted. No other abnormal findings were observed on systemic examination. In the hospital, peripheral blood smear, bone marrow aspiration, and EBV serology were performed, leading to the diagnosis of infectious mononucleosis.

Conclusion: While a markedly elevated white blood cell count due to EBV infection is rare, leukemia must always be ruled out, especially in the absence of significant physical findings.

CUTIS MARMORATA TELANGIECTATICA CONGENITA: A CASE REPORT

2025-02-16T07:50:24+01:00

Introduction: A very rare congenital vascular malformation − Cutis marmorata telangiectatica congenita, also known as Van Lohuizen syndrome is characterised by the presence of a bluish-violet reticulated. Although this malformation has been known for over a century and 485 cases have been reported up to the year 2019, the aetiology is still not clearly understood. On the contrary, the prognosis is good for this vascular malformation, as the changes usually 'fade' by the age of two, provided there are no associated anomalies.

Our aim is to present such a case, which was seen for the first time during the long-term practice with pre-school patients at the Health Centre in Niš.

Case report: The vascular malformation, diagnosed as cutis marmorata telangiectatica congenita, was located on the left leg, from the gluteal region to the lower quarter of the anterior crural region, i.e. the calcaneal region (posterior), and on the left lumbar region of the back in a male infant. All recommended tests and necessary consultations with other specialists were carried out. Apart from a slight left-right difference in the circumference of the lower limbs, no other variations or abnormalities were found.

Conclusion: The unclear cause and the rarity of this vascular malformation (cutis marmorata telangiectatica congenita), although transient, inspired the author to present it, as it was her first discovery in 23 years of paediatric practice.

NECROTIZING PNEUMONIA CAUSED BY STREPTOCOCCUS PNEUMONIAE IN A FIVE-YEAR-OLD BOY - A CASE REPORT

2025-02-21T07:37:11+01:00

Introduction: Necrotizing pneumonia is one of the most serious complications of community-acquired pneumonia, caused by infection with particularly virulent bacteria. Streptococcus pneumoniae is the most common agent. It typically occurs in previously healthy children and leads to a prolonged clinical course despite appropriate antibiotic therapy.

Case outline: A five-year-old boy, who was regularly vaccinated and had no chronic illnesses, presented with a 14-day history of fever and cough, followed by difficulty breathing and right-sided abdominal pain. Oral antibiotic therapy (azithromycin) was started just before admission. As the symptoms persisted, radiological diagnostics were performed, and the diagnosis of pleuropneumonia was made, leading to hospitalization. Upon admission to the hospital an ultrasound and chest computed tomography were performed, confirming bilateral necrotizing pneumonia with massive right-sided pleural effusion, as well as thrombosis at the junction of the left jugular and subclavian vein. Treatment included parenteral antibiotic therapy, thoracic drainage with the administration of alteplase, and anticoagulant therapy. The pleural effusion, based on its biochemical characteristics, corresponded to empyema, and the culture was positive for Streptococcus pneumoniae. The disease required a prolonged hospitalization of 24 days with a positive clinical outcome.

Conclusion: The diagnosis of necrotizing pneumonia should be considered in any child with pneumonia that does not improve 72 hours after appropriate antibiotic therapy. Early diagnosis and timely treatment are crucial for a positive outcome, while regular vaccination remains the primary preventive measure.

CASE REPORT OF A 17-YEAR-OLD MALE WITH BRONCHIAL TUMOR (CARCINOID)

2025-03-04T11:17:37+01:00

Introduction: The incidence of pulmonary carcinoids has increased in recent decades. Although most commonly diagnosed in adults, pulmonary carcinoids can also occur in children. Detection typically occurs through chest X-ray, with diagnosis confirmed by CT, bronchoscopy, and histopathological analysis. Surgery is the primary treatment, and before metastasis occurs, it is generally curative. Prognosis depends on the tumor type, disease stage, and presence of metastasis.

Case outline: A 17-year-old adolescent was hospitalized for pneumonia. Following treatment, clinical improvement was observed, and a follow-up radiography showed regression of the changes. One month after discharge, the patient returned with progression of symptoms, leading to second hospitalization. Chest CT scan and bronchoscopy revealed a mass completely occluding the left main bronchus. Histological analysis of the biopsy confirmed a carcinoid tumor and left upper lobectomy was performed.

Conclusion: Pulmonary carcinoid tumors present a challenge in clinical practice due to their nonspecific clinical course. Our case emphasizes the importance of a comprehensive diagnostic approach and early detection of the tumor, which is crucial for better prognosis.